In an article published to Fortune, Jessica Starr, MD, endocrinologist at HSS, and Emily Stein, MD, MS, Co-Director of the Skeletal Health Orthopaedic Research Program at HSS, recommend that patients taking GLP-1 medications work closely with their physicians and incorporate exercise and strength training into their treatment plans to preserve long-term musculoskeletal health.

Read the full article at Fortune.com. A subscription is required to access.

Osteoporosis is the condition through which bones become weak and brittle. We lose calcium naturally as we reach 50 years of age, Dr. Drake said, but that rate can be exacerbated when we don’t take in enough calcium, and the body must rob it from bones to survive.

The body is constantly creating and breaking down calcium, using cells known as osteoblasts and osteoclasts. When osteoblasts fall behind the osteoclasts and the body steals calcium from bones, the bones become weak and brittle and can break. This often happens when older folks fall.

“Just moving and supporting yourself is one of the best things you can do,” he said. “I spend a lot of time with patients talking about limiting their risk for falls. That’s one of the biggest risks for having broken bone is having a fall.”

And just as people seeking to drink enough water each day don’t take it in at one time, calcium for bone strength is best if it’s taken in throughout the day, said Dr. Drake. Meals, for example, should include a solid source of calcium, and that can be enhanced with a supplement.

Read the full article at mankatofreepress.com. A subscription is required to access.

Dr. Starr emphasized that bone is not a static structure. "We think of bones as a hard substance that's just there. But bone is very much alive," she said. "Bone is constantly changing; it's building up, and it's breaking down at different rates throughout life."

She highlighted the importance of adequate calcium and vitamin D, regular weight-bearing and resistance exercise, and evaluation for underlying conditions that can accelerate bone loss, including menopause, diabetes, thyroid disorders, and certain inflammatory diseases. Dr. Starr also noted that fragility fractures, such as a broken hip after a minor fall or a vertebral fracture from coughing, can be a telling sign of weakened bones. 

For individuals at higher risk, Dr. Starr recommends discussing bone density testing with their healthcare provider, even before the standard screening ages. She also encourages patients to seek guidance on prevention and treatment options. "It's definitely worth having a discussion with a healthcare provider," she said

To read the full article, visit HealthRadar.com. A subscription is required to access.

Although osteoporosis is common—around 10 million people over age 50 have it—the condition is still misunderstood. To set the record straight, Alana C. Serota, M.D., internal medicine physician at HSS, shares what many patients get wrong—and what everyone should know— about osteoporosis and bone fractures.

Because the words sound the same, osteoporosis and osteoarthritis, wear-and-tear joint damage, often get conflated, Dr. Serota said. However, the conditions are completely unrelated. “One is in the joints and one is in the bones,” she noted. While osteoporosis doesn't hurt unless you break something, osteoarthritis can be quite painful day-to-day. Also, notably, the two conditions have completely different prevention strategies and treatments, so it’s important to read up on both to understand the differences and how each may play a role in your health (or not).

Read the full article at healthcentral.com. 

Dr. Starr explains that when treating osteoporosis, there is no one-size-fits all approach. Different medications are available, and treatment should be tailored to a woman’s specific needs. A healthy lifestyle is essential to help preserve bone health, including a nutrient-rich diet and adequate intake of calcium and vitamin D. The daily recommendation for women ages 51 to 70 is 1,200 mg of calcium and 600 international units (IUs) of vitamin D. For women who are 71 and older, the recommendation is 1,200 mg of calcium and 800 IUs of vitamin D. Calcium-rich foods include dairy products; calcium-fortified orange juice; dark, green leafy vegetables, and fish, like salmon and sardines. Since it may be challenging to get the recommended daily amount of calcium from foods, women often take supplements. To obtain the most benefit, they should not exceed 500 mg or 600 mg at one time because our bodies cannot absorb more than that. If a calcium gummy has 500 mg, for example, it should be taken twice a day. For women taking a multivitamin containing calcium, it is advisable to take a calcium supplement later in the day.

The full article appeared in the print edition of Newsday on April 30, 2024.

“Osteoporosis is a silent disease — until it’s not,” said Dr. Starr. She explains that osteoporosis just means that the natural holes or pores in our bone are bigger than they should be on a bone density test.  

“When they get bigger beyond a certain pre-defined score, we call it osteopenia,” said Dr. Starr. “And when it gets even bigger than that, we call it osteoporosis. But just having those holes in the bone and having them be large is painless.” 

But here’s the thing: even if you don’t feel it now, the risks are real. When these holes or pores get bigger, your bones get more fragile, your muscle mass diminishes, and your risk of falls and fractures increases.  

Ensuring strong bones requires attention at all stage of life. Osteoporosis isn’t just an issue confined to older individuals. An increasing number of people in their 20s, 30s, and 40s are receiving diagnoses.  

While immediate medical treatment may not be necessary for every diagnosis, especially in younger, fit individuals with milder forms of osteoporosis, it’s essential to engage in an open conversation with healthcare providers about steps to fortify bones and prevent fractures. 

“Doing something is better than doing nothing,” said Dr. Starr. “If someone promises me they’ll attend physical therapy for strength training and take some calcium, it’s still a step forward from when I first met them at the door where they weren’t doing those things.” 

Read the full article at creakyjoints.org

Falls might not seem like a big deal to many, but for older adults or those with or at risk for the bone-thinning disease osteoporosis, they can have serious consequences. Falling can lead to severe injuries, make daily tasks harder, reduce your quality of life, and take away the freedom to live independently. In some cases, falls can even be life-threatening. 

As you get older, it’s smart to re-evaluate your home, even if you’ve been living there for decades. “What was safe when you were 40 is not okay anymore when you’re 75 or 80,” said Dr. Starr. Look out for potential hazards like loose rugs. Make sure there’s proper lighting, especially near staircases, and that banisters are sturdy. If your bathtub is high, consider installing support handles to help you get in and out safely. 

Something as simple as being more conscious of your everyday movement can be a powerful fracture prevention step. “Slow down and don’t go up and down the stairs carrying things,” said Dr. Starr. “Go up and down the stairs holding the banister.” 

Read the full article at creakyjoints.org. 

Dr. Goolsby specializes in the non surgical treatment of bone stress fractures and overuse injuries. “I think the most important thing for stress fractures is figuring out why it happened so trying to address any of those risk factors. I ask my patients about their training and what changes there have been, what kind of shoes they wear, do they have low vitamin D, are they a vegetarian, do they have history of an eating disorder or menstrual issues?  A lot of it is activity modification. If it hurts, don't do it,” explained Dr. Goolsby. 

Dr. Goolsby discussed the importance of proper nutrition and creating the right culture and messaging about the importance of appropriately refueling for their sport. I use my sports nutritionists and sports psychologists a lot. It's really a team. 

“A lot of it is education and making sure people understand not getting your period might be common, but it isn't normal. The implications of that on various systems, but usually the bones are the ones that are front and center because they are at increased risk of getting stress fractures and early osteoporosis.”

Dr. Goolsby discussed the prevalence of ACL injuries especially in female athletes. “ACL injury prevention is very important for females in particular. We have a lot of injury prevention programs set up at HSS and even have an app to keep people engaged in ACL injury prevention,” said Dr. Goolsby. 

Watch the full interview at youtube.com. 

Osteoporosis is often called a “silent” disease because people typically have no symptoms. They often don’t know they have it until they break a bone in an unexpected way. Osteoporosis develops when bone mineral density and bone mass decrease. This can lead to weakened bones and an increased risk of a fracture. The hips, spine and wrist are most susceptible.

Earlier screening is recommended for women with certain risk factors for bone loss, such as a family history of fractures or the use of certain medications such as steroids. Those who consumed very little calcium in younger years, had an eating disorder, smoke or consume excessive amounts of alcohol may also be vulnerable to accelerated bone loss, Dr. Starr noted. Anyone with a diagnosis of either osteoporosis or osteopenia should talk to her doctor to develop a strategy to prevent further bone loss, she said. The plan may include lifestyle changes and possibly medication. “There’s no one-size-fits-all approach to treating osteoporosis,” she explained. “Different medications are available, and treatment should be tailored to the needs of each individual.”

This article appeared in the June 7-June 13 print issue of Good Health. 

Uncontrolled diabetes is like a wrecking ball that crashes into your entire body. Left unchecked, this insidious illness can wreak havoc on multiple organ systems. Over time, your cardiovascular system, neurological function, kidneys, oral health, and even your eyes can suffer damage from drastic blood sugar fluctuations.

"Diabetes is more than just problems with blood sugar. It's a state of chronic inflammation,," said Dr. Starr. 

At least four spinal conditions are thought to be linked to diabetes including lumbar disc degeneration, spinal stenosis, spinal epidural abscess, and vertebral osteomyelitis. The disease can affect each condition’s development in a different way.

Dr. Starr said that none of these spinal conditions directly causes diabetes development. However, she offered an important caveat on this issue.

“Getting epidural steroid injections for pain related to these conditions can lead to diabetes in someone predisposed, like in someone with pre-diabetes at baseline,” she advised.

At the opposite end of the spectrum, Dr. Starr stated that diabetes does not specifically cause any of these spinal conditions. However, uncontrolled blood sugar can set the stage for a condition’s development.

“Having poor glycemic control can make the risk for bone infections, like vertebral osteomyelitis, higher,” she explained.

Read the full article at healthcentral.com. 

Since collagen is a protein, and protein is generally good for bone health, collagen supplements may be beneficial, advised Dr. Russell.  “But it probably doesn’t incorporate into bone” or reduce the risk of osteoporosis, she said. 

She recommended steps such as consuming sufficient amounts of vitamin D and calcium, exercising and maintaining a healthy weight. 

“There are many other things that support bone health,” said Dr. Russell.

Read the full article at WSJ.com.  A subscription is required to access.

“Walking affects multiple systems in the body, and so it offers a lot of great benefits,” noted Dr. Robinson. When walking, Dr. Robinson suggested a pace that gets their heart rate up a bit. Being slightly breathless but not completely out of breath; use the “talk test” as described above. “That’s a good monitor that the walking you’re doing will improve your cardiovascular fitness,” said Dr. Robinson.

Dr. Robinson recommended aiming for 150 minutes of this type of walking per week, spanning multiple days. This is in line with the Physical Activity Guidelines for Americans from the U.S. Department of Health and Human Services, which recommends 150 minutes of moderate-intensity aerobic exercise per week for adults (or about 30 minutes, five days a week). 

Walking is a weight-bearing exercise, so it may help to preserve bone health and potentially decrease osteoporosis risk, said Dr. Robinson. What’s more, walking also improves core strength, increasing stabilization and balance to help prevent falls as you age, he added.

For the biggest benefits to the bones, Dr. Robinson advised combining walking with a strength-training program.

Read the full article at Everydayhealth.com.

The guideline also recommends sequential therapy (any treatment regimen in which the patient is given one treatment followed by another), which was not addressed in the previous guideline. The recommendations for sequential therapies are based in part on some study designs, long-term follow-up studies, and new clinical trials.

“Some physicians may be surprised about the need for sequential therapy when completing a course of denosumab, parathyroid hormone/parathyroid hormone related protein, or romosozumab. If not done, patients could be at risk of rapidly developing vertebral fractures and bone loss,” said Linda A. Russell, MD, rheumatologist and director of perioperative medicine and the Osteoporosis and Metabolic Bone Health Center at HSS and co-principal investigator of the guideline.

Furthermore, the updated guideline also gives more flexibility on drug selection and considers patient and physician preferences.

Read the full article at the-rheumatologist.org.  

Additional coverage: Medscape.com. 

Dr. Serota recommended wearing low-heeled, sturdy shoes and using any necessary assistive devices such as canes, walkers, railings or grab bars.

She said to clear the floor of extension cords, loose area rugs, toys/games/clutter and to have a well-lit path to the bathroom at night and use a flashlight in dark, unfamiliar areas (inside or out).

She also advised getting regular vision and hearing checks. She noted that hearing plays a critical role in fall prevention because it allows us to localize ourselves in space and contributes greatly to balance. An untreated 25 decibel hearing loss triples the chance of falling (based on a study of adults ages 40-69).

“So I am very much an advocate for getting regular hearing checks and, if warranted, using hearing aids,” Dr. Serota noted.

Read the full article at Chchearing.org.

The study was led by Titilayo Ologhobo, MPH, Director, Outcomes and Data Analytics at HSS, and found after attending biweekly 60-minute low-intensity Zoom fitness classes at six-week increments, participants improved physically and became more socially active.

Ologhobo explained, “We made sure our classes were structured to increase interactions with others. We promoted a dialogue before the class began so people could talk and catch up with each other. They said it helped promote social connections.”

Read the full article at Everydayhealth.com. Additional coverage: Prevention.com, Healio.com.

Dr. Stein and Shannon Clare, research assistant and first author of the study, cited “Our results are notable because we found that the duration of suppression of bone formation extended beyond 12 weeks, a far longer duration than seen previously with intra-articular injections [of glucocorticoids].”

According to the authors, women are not typically screened for osteopenia or osteoporosis before ESI. However, Dr. Stein and Clare noted, “Our results suggest that physicians should consider screening women for osteoporosis who receive ESI, particularly those who are treated with multiple doses. Steroid exposure should be minimized as much as possible by having patients space injections as far as they can tolerate."

The authors stated that further studies are needed of the relationship between these short-term changes in bone turnover and bone loss and the risk for fracture among the burgeoning population treated with ESIs.

Read the full article at Medscape.com.

According to Dr. Goolsby, “With bone health there are things you can control and things you can’t control. We can’t control our genetics which plays a huge role in osteoporosis. Some bone loss over time is unavoidable and some aspects you may be able to slow.”

Dr. Serota underscored the bone is rich in estrogen receptors and that estrogen is important to maintaining bone density. She noted, “At the time of menopause and there’s less estrogen…there is very rapid bone loss in the first five years after the last menstrual period.”

Listen to the full episode at Podcasts.apple.com.

Dr. Nwachukwu advised beginners to ease into it, otherwise the risk of overuse injuries increases. He recommended starting with 30 seconds of jumping, interspersed with similar periods of rest, and to gradually increase the length of the interval.

Jumping rope can help build bone density as a result of the impact of jumping, noted Dr. Nwachukwu. This matters because bone density tends to decrease with age, he explained, which can lead to conditions including osteomalacia (pronounced softening of the bones) and osteoporosis, and predispose you to fractures. By building bone density through activities like jumping rope, you can reduce your risk of these issues, added Dr. Nwachukwu.

Read the full article at Self.com

Infectious Disease Advisor spoke to experts who discussed the effects of ART on bone health in PLWH, including Jessica Rachel Starr, MD, endocrinologist at HSS. Dr. Starr explained, “ART, when given intermittently vs continuously, has a better effect on BMD decline, meaning bone density is less negatively affected when patients take breaks from the antiretroviral agents.” She added, “This is a complex topic and highlights how HIV has become a chronic disease, meaning patients with HIV are living long enough to develop chronic age-related conditions such as osteoporosis, although they are perhaps developing these conditions at an earlier time in life and with a higher degree of severity than their HIV-negative peers.”

Dr. Starr expressed the need for further research, stating, “Additional research is needed to tease out the relative contribution of the HIV itself to low BMD vs the medications used to control the virus. There is also a need to determine whether ART affects bone metabolism or vitamin D metabolism or both.”

Dr. Starr also addressed key considerations for clinicians, citing, “Osteoporosis and osteopenia are more common in women, older patients, and those with lower body weight. All patients with HIV should have BMD screening before initiating treatment with ART.”

Read the full article at Infectiousdiseaseadvisor.com.